Literature review
The first necessary step in this study was to identify relevant literature. Literature that focused on the nexus between mental health issues and the justice system, written in the last 20 years, was considered key. Health and legal databases were both investigated for the Project. The focus was on literature relating to mental illness and access to justice in NSW and Australia; however, international literature was also drawn on where it described innovative models for enhancing access to justice for people with a mental illness.
Methods
Roundtable discussions with service providers, advocates and other stakeholders
The next significant step in framing the focus of the Project was the conduct of two half-day roundtable discussions with legal and non-legal service providers, advocates and other stakeholders. A total of 16 people attended these discussions, held on 3 June and 16 June 2004. Those who attended included solicitors from CLCs, advocates, mental health service providers and workers from community organisations who support people with a mental illness.
Roundtable attendees were asked to provide insights on the following issues:
Consultations/interviews with stakeholders
A key component of this study was individual interviews conducted with stakeholders. These stakeholders were chosen because of their experience in working with people with a mental illness and their informed perspectives on the barriers their clients face in accessing the justice system.
Those interviewed included academics, government policy staff, private legal service providers, CLC solicitors, Legal Aid staff, mediators, counsellors, court staff, tenancy workers, advocates and trainers in disability awareness issues. Most interviews took place between August 2004 and March 2005. A complete list of the agencies consulted for the Project is included in Appendix 1. Twenty-nine were from legal service providers, 24 were from non-legal services, 14 were from government departments and agencies and 10 were from courts or tribunals. Four academics were also consulted. Interviews were conducted with individuals and in groups. Most interviews were face-to-face although a small number were conducted by telephone. Interviews lasted between 30 and 90 minutes.
The interview schedules included a number of open-ended questions, a subset of which was covered in all interviews. Other questions were tailored to the particular expertise of the interviewee. An example of the interview schedule for legal service providers and the schedule for non-legal service providers are attached in Appendices 2 and 3.
Interviews with people who have a mental illness
Thirty semi-structured interviews were conducted with people who have a mental illness (see Appendix 4 for the interview schedule).1 The term ‘participants’ is used in the following chapters to describe these interviewees. Participants were contacted through a range of organisations providing services to people with a mental illness in NSW (see Appendix 5). Of the 30 people interviewed, 17 were men and 13 were women. One participant was Indigenous, and five were living in rural or regional NSW at the time of the interview. Six participants were young people (under the age of 25).
Interviews were conducted at the contact organisation and, in one case, at the Foundation’s office. Each of the researchers who conducted these interviews had an honours degree in psychology and/or sociology and had received additional training from St Vincent de Paul Learning Services in interviewing people with complex needs.
Interviewers introduced themselves to participants providing a short description of the Foundation and the research project. In order to ensure informed consent, participants were provided with an information and consent form (see Appendix 6). The form outlined that participation was anonymous and voluntary, that the participant could choose not to answer any questions, and they could stop the interview at any time. The interviews were to be recorded with the permission of the participants and transcribed material would be kept securely, and the tape erased once transcribed. All participants were reimbursed $20 for their time.
Once both the participant and interviewer signed the consent form, the interviewer commenced the interview by asking participants if they had a recent legal problem or issue in their life. If the participant indicated that they had a legal problem, they were asked what had happened, whether they sought help, who they had sought help from, if they had not done anything about it, why this was the case, and what happened in the end.
It was important to allow for the likelihood that participants would not necessarily be able to identify problems they had experienced as being legal. Therefore, whether or not participants nominated a legal issue in response to the first question, they were then asked a series of questions regarding different areas of the law and legal problems that had been identified by stakeholders as being particularly relevant to people with a mental illness in NSW. These included housing, income and employment, debt, fines, family issues, crime and victim of crime issues, relationships with police and health issues. If the participant indicated that they had any of these legal issues, they were asked the same questions listed above regarding whether they sought help and the outcome of the problem.
Use of other data sources
As noted in Chapter 1, data reported by agencies such as the ABS and AIHW on the prevalence and the correlates of mental illness provide an important backdrop for this study and have been drawn upon in our report.
Another source of data utilised for the Project was the data collected by the Foundation for the Legal Needs Survey conducted in late 2003.2 This household survey involved a quantitative telephone survey of 2400 people in six regions in NSW. It was not the purpose of the study to obtain representative sub-samples of specific disadvantaged groups such as people with a mental illness; rather the purpose of the region survey was to survey six disadvantaged communities as a whole. Nonetheless, 56 people who participated in this study indicated that they had a mental health problem. It was determined, however, that this small sample of people with a mental illness was unlikely to be a representative group, given the varied living arrangements of people with a mental illness, which can include shelters, refuges and boarding houses.3 Therefore, rather than use the information quantitatively, the responses provided by these participants were investigated as individual case studies. Where these cases provide information relevant to our report they have been incorporated.
It was hoped that additional data could be provided by the agencies consulted for our study. Unfortunately, legal agencies were unable to provide data to us on the mental health status of their clients, and non-legal agencies were unable to provide data on legal issues experienced by their clients with a mental illness.
Data analysis
The transcripts of all consultations for the study were entered into the qualitative software analysis program QSR NUD*IST Vivo (NVivo). NVivo is commonly used by qualitative researchers to organise rich data from interviews. Information is categorised under particular ‘nodes’ (or themes) that can be developed prior to coding or as the analysis progresses. In this case, most nodes were developed before data was entered into the NVivo database. Nodes were based on themes identified in earlier research, particularly as part of the Foundation’s Access to Justice and Legal Needs Program (e.g. areas of law/legal issue, types of barriers to accessing legal assistance). New nodes were added where required.
Strengths and limitations of the study’s design
The range of experience of the stakeholders we interviewed, and the depth of their understanding of legal and other issues experienced by people with a mental illness, are key strengths of this study. Another key strength is the perspective and insights provided by people who have a mental illness themselves. The barriers they perceived and experienced in addressing their legal issues add great richness to this study’s results.
Another important component in this study’s design was the inclusion of people with a mental illness (often referred to as ‘consumers’ in the literature) as advisors at key stages of the research processes. Advocates, researchers and trainers in the area of mental illness, who had a mental illness themselves, provided input into roundtable discussions, sampling methods and interview schedule design.
It is important to note that the purpose of this study was not to use quantitative sampling techniques that would provide a representative sample and would therefore allow us to generalise our results to all people with a mental illness in NSW. Such a design would have been appropriate if more were known about the legal needs and access to justice issues experienced by people with a mental illness at the outset of the study.
Given that key data collected for this study was based on consultations, it is also important to note the inherent weaknesses of self-report data—that is, data that is based on the subjective experiences of those interviewed. In interviewing people with a mental illness and stakeholders we were interested in gaining insight into their experiences, recognising that perceived barriers can be as insurmountable as actual barriers. We were also mindful, however, that at times interviewees may not fully understand or be aware of laws, legal and bureaucratic processes or legal services. Therefore, we have, where possible, sought to further investigate and verify some of the statements made by interviewees.
Reporting of findings in the following chapters
In line with the aim of this study, reporting in the following chapters will focus on presenting the range of issues and experiences raised by those we consulted. This report does not seek to quantify legal needs experienced or to generalise to all people with a mental illness. Where supporting literature is strong or where many of those we interviewed raised a particular issue, more weight will be given to this issue and the possibility of extrapolating this finding more broadly will be suggested.
Executive Summary
Ch 1. Introduction
Ch 2. Methodology
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